There are other legal arguments against the case, too — including the question of whether these states even have the ability to bring the lawsuit to court in the first place. A federal district court judge in Texas struck down the mandate and the rest of the law in late , and an appeals court partially upheld that decision a year later, ruling that the mandate was unconstitutional. The appeals court asked the lower court to reconsider the extent to which the mandate could be separated from the ACA.
The big question, from a political perspective then, is what Congress could do to deal with the chaos that would inevitably ensue. The answer is complicated, as control of the Senate most likely hangs on two runoff elections in Georgia in January. Roberts noted that if Congress passed a law requiring everyone to mow their lawn once a week, even if there was no penalty, there "will certainly be injury" to those who didn't comply.
Justice Clarence Thomas said that such a law could still have a "chilling effect. A ruling siding with the red states by invalidating the individual mandate, but with the blue states by allowing the bulk of the Affordable Care Act to remain standing, would represent a win for Democrats. Health-care activists said that if the Supreme Court struck down the Affordable Care Act, more than 20 million people could lose their insurance. The dispute, which was argued in the shadow of last week's presidential election, was a central focus of Democrats during the confirmation hearings for Justice Amy Coney Barrett last month.
After the late Justice Ruth Bader Ginsburg, a liberal, died in September, Democrats sought to turn the fight for her replacement, Barrett, into a referendum on the law.
In that regard, Barrett's questioning on Tuesday was anticlimactic, as it didn't provide much insight into her thinking about the legal issues. The case had also become a political flash point in the race between Trump and President-elect Joe Biden, who have sketched out vastly different visions for the future of American health care.
Trump pushed to gut the Affordable Care Act, while Biden's agenda calls for building on the law, which the former vice president played a role in shepherding through Congress in the first place. The political stakes were amplified by the pandemic, which has killed more than , in the U.
Efforts to contain the pandemic also caused a devastating recession, which has resulted in millions losing their health-care coverage. However, on March 2, , before the district court could carry out the appellate court's directive, the Supreme Court announced it would hear the case in its term beginning in the fall of , blocking the lower courts from taking further action. The case the Supreme Court will decide is now titled Texas v.
When the 5th Circuit instructed the district court to rehear the matter and to focus on those ACA provisions that Congress intended to be "inseverable from the individual mandate," this suggested, legal analysts said, that the appellate court was unlikely to overturn the ACA in full.
As a result, "plan sponsors know that the entire Affordable Care Act will not be overturned. Had the case proceeded at the appellate level, the 5th Circuit might have struck down those parts of the law directly related to the individual mandate. The appellate decision noted, for instance, that community rating, which prevents insurers from varying premiums within a geographic area based on age, gender, health status or other factors, might be among the provisions determined to be "inseverable" from the individual mandate, because the increase in revenue to insurers from the mandate was meant to offset the decrease from these restrictions.
The ACA's guaranteed-issue provisions, which ban insurers from rejecting coverage based on a person's pre-existing conditions, might also be inseverable, the appellate decision noted. The Supreme Court has the following options when it decides the case , The Washington Post and other sources have reported:. According to an analysis by the nonprofit Kaiser Family Foundation , "If the Supreme Court adopts the position that the federal government took during the trial court proceedings and invalidates the individual mandate as well as the protections for people with pre-existing conditions, then federal funding for premium subsidies and the Medicaid expansion would stand, and it would be up to states whether to reinstate the insurance protections.
If that were to happen, Congress also could reinstate protections for people with pre-existing conditions.
Joe Biden, the Democratic presidential nominee, has voiced his support for the ACA, sometimes referred to as Obamacare, pointing out how it safeguards people who might not otherwise qualify for coverage. His campaign website says, "Because of Obamacare, over million people no longer have to worry that an insurance company will deny coverage or charge higher premiums just because they have a pre-existing condition —whether cancer or diabetes or heart disease or a mental health challenge.
President Trump has also pledged to maintain these protections even as his administration supports the lawsuit that seeks to overturn the act. During his acceptance speech for the Republican presidential nomination , Trump said, "We will always, and very strongly, protect patients with pre-existing conditions, and that is a pledge from the entire Republican Party. The individual mandate is most closely linked to ACA provisions on guaranteed issue and federal subsidies to insurers, said Kathy Bakich, national health compliance practice leader at Segal, an employee benefits consulting firm.
But there's a possibility the justices could consider the mandate that employers with 50 or more full-time employees provide ACA-compliant coverage to full-time staff. The Supreme Court could issue a ruling that maintains the status quo and leaves the appellate decision intact , wrote Katie Keith, a former research professor at Georgetown University's Center on Health Insurance Reforms and a contributor to the Health Affairs blog.
In that instance, "the 5th Circuit's ruling would stand and the case would be remanded back to the district court," she noted. If that is the outcome, "the ACA would remain in effect while the district court undertook a provision-by-provision severability analysis," Keith noted. Thinking Ahead. If the employer 'play-or-pay' mandate the hour rule were struck down, would an employer move full-time eligibility back to 40 hours?
But legal scholars on both sides of the ideological line doubt the court will go that far. What are they fighting about? What could the justices decide? The court could also rule the mandate is not severable and strike down the law entirely. How likely is the court to strike down Obamacare? Why is it taking so long? The court is scheduled to release more opinions on Thursday starting at 10 a.
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